Lisa’s call to Medicare
Lisa Hoffman & Charles Atkins, MD
Published December 8, 2005
If you think you’ve had enough of Medicare D, the terror has just begun. So today it’s time to see if Lisa can figure out which of the dozens of prescription drug plans (PDPs) she should choose.
We start by dialing 1-800-Medicare; she makes it through on the first try and puts the phone on speaker. The time is 10:20. After telling a recording that we’d like our instructions in English, she’s instructed to say "Drug Plan" out loud. The voice tells us to say "Enrollment" and encourages us to have our Medicare card ready. So far so good and hope surges as we move toward our goal.
Balancing several brochures and her purse on her lap, Lisa struggles to keep up.
The voice asks her to have her list of medications handy, and she’s reminded for a second time to have her Medicare card number and that the call may be monitored for quality control. Fair enough, as we’ve got the phone on speaker and I’m typing the whole thing.
Lisa is then transferred to a live person—Erika--who proceeds to ask for various pieces of information; kind of like name, rank and Medicare number.
"Okay, Ma’am it will be just one moment." We hear a bit of music and are transferred to a second person—Rebecca.
"I’m interested in choosing insurance for my medications," Lisa says.
"Can I have your Medicare number?" Rebecca asks for the fourth time.
"Okay, let’s make sure I get this right," and Rebecca repeats back the number and asks for Lisa’s name. "Can you verify your date of birth? And you do have part A and part B of Medicare? Are you interested in a Medicare drug Plan? Do you know which one you’d like?"
"No, that’s why I’m calling."
"I’ll then help you by using the Internet drug plan finder. Now we don’t have all the information from employers and from people who will be getting extra help with the drug plans." And she makes one or two other disclaimers that give me the distinct impression that the bugs have not been worked out. "Now Miss Hoffman there are 45 plans available in your area…do you have a list of your prescription drugs?"
Lisa read her meds…There are ten. She spells each for Rebecca. And when she gets to Coumadin she tells her that she needs the name brand.
"Okay," Rebecca says, "now I need the dosages." And she calculates how many of each pill will be taken a month. We go through all ten, at which point Rebecca lets us know that there are 19 plans available that cover all of Lisa’s medications.
I nearly fall out of my chair, knowing how difficult it is to choose between even two or three plans. I’m also struck at the sheer number of insurance companies who have entered this market; it’s astounding.
"Did you get specially trained for this?" Lisa asks, Rebecca.
"Yes, Ma’am…last week as a matter of fact. Now I can go back and look." And one by one she goes through the plans, each of which has different monthly fees, deductibles and per-prescription co-pays. She then asks Lisa what pharmacy she uses, as not all of the plans use all pharmacies.
By the time we’ve heard about all of the available plans it’s clear that Lisa couldn’t possibly decide which will be best without sitting down and calculating each, taking into account the fees, deductibles and co-pays.
Rebecca tells Lisa that she can send her information on all of the plans.
Lisa says, "Oh that would be wonderful."
I think it’s anything but wonderful, imagining how much work will be involved with comparing the options, and trying to cost out the co-pays for each of her ten medications. I wonder if that information is even available, as every pill could well have a different co-pay.
The call ends with Lisa being given a confirmation number; it’s 10:47, roughly half an hour.
After she hangs up, Lisa turns to me, "Was that helpful? I didn’t understand most of it. If you weren’t here I don’t know what I would have done."
"That’s what I was worried about," I say, realizing we’re only slightly closer to selecting a plan. Suddenly, I’m struck at how signing up for a Medicare D prescription drug plan is a bit like an Arthurian quest, where the intrepid knight (Lisa in this case) must advance through a series of increasingly difficult hurdles, and only if found courageous, persistent and pure of heart will he/she win the day. All of which begs a few questions, why is this so difficult? Why, as the January first go-live date approaches, haven’t the architects of this plan thought through the details so that the average Medicare recipient can easily figure out what it is they need to do? And the question that all taxpayers should ask is who, other than these very eager insurance companies, is really going to benefit from this new benefit?